Purpose: To provide a thumbprint in a bottle keepsake for the family of end-of-life patients and support their healing process.
Description: A shared governance referral was received from a unit educator to create a keepsake for family of end-of-life patients. An article from Clinical Journal of Oncology Nursing titled “Nursing Care at the End of Life” concluded that one way of helping family members during the peri-death experience is to create a memory keepsake (Boyle, 2019). Creating memory keepsake reduces family distress and enhance nurses’ satisfaction with their role in facilitating a “good death” (Boyle, 2019). Our research also states that “...keepsakes are tangible items that are highly valued by family members and the creation of the keepsake with the clinical staff as a valuable experience and viewed as a gesture of compassion” (Neville et. al, 2020).
Our group brainstormed for keepsake ideas that are meaningful for the family and effortless for the staff to create. Our group decided to adopt similar concept as the Heartbeat in a bottle the critical care units provide their patients' families. Since patients in the med-surg units are not in cardiac monitors, one group member suggested using the patient's thumbprint instead.
The thumbprint in a bottle keepsake was presented to the med-surg staff and staff were asked for their feedback. Our team collaborated with project lead for heartbeat in a bottle keepsake to determine their process and how the keepsake is perceived by staff and patient's families. The risk management was consulted to ensure obtaining thumbprint for the purpose of end-of-life keepsake remains in compliance with our hospital's HIPAA policies and procedures. Lastly, our team reached out to our hospital's palliative care team to inform them that their team may offer the keepsake to family (when appropriate) during their palliative consults.
A small piece of paper with the patient's thumbprint is placed inside the small bottle. A purple ribbon is used to secure a tag with the phrase "I will always be with you" (available in English & Spanish) tied on the bottle’s rim medical-surgical staff were educated using e-learning method. 91.89% of staff from the medical-surgical cluster
completed the e-learning module.
Evaluation/outcome: Our team understands that every aspect of end of life is a very difficult time for family; nurses play an essential role with assisting patients and their families through the death and dying process. End-of-life conversations are also never easy. Despite these difficult conversations, our thumbprint in the bottle keepsake was perceived positively by staff and patient’s family. Explaining the process and its purpose helped family understand the goal of our project and helped them through their healing process. Our team recognize that patients may pass away unexpectantly in the emergency department. We plan to extend our thumbprint in the bottle keepsake to the family of patients who die unexpectedly in the emergency department and hope to help them with the pain and grief of losing a loved one.
Evidence-based references
1. Neville, T. H., Clarke, F., Takaoka, A., Sadik, M., Vanstone, M., Phung, P., Hjelmhaug, K., Hainje, J., Smith, O. M.,
2. LeBlanc, A., Hoad, N., Tam, B., Reeve, B., & Cook, D. J. (2020). Keepsakes at the End of Life. Journal of Pain and Symptom Management, 60(5), 941–947. https://doi.org/10.1016/j.jpainsymman.2020.06.011
3. Boyle, Deborah A.; Clinical Journal of Oncology Nursing, Feb2019; 23(1): 13-17. 5p. (Article - nursing interventions, protocol, research) ISSN: 1092-1095, Database: CINAHL Complete
4. Visser, Renske C.; Parrott, Fiona R.; Mortality, Feb2015; 20(1): 19-35. 17p. (Journal Article - research, tables/charts) ISSN: 1357-6275, Database: CINAHL Complete